ArticleBMJ open2014
Incentivised case finding for depression in patients with chronic heart disease and diabetes in primary care: an ethnographic study.
Article in BMJ open, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed.
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- Article
- Identifying impaired mental health in patients with type 2 diabetes: a cross-sectional study in general practice.BJGP open · 2025Article
- Advanced Nurse Practitioner (ANPs) experiences of the Quality and Outcomes Framework (QOF) Scheme: a UK case study.BMJ open · 2024Article
- Managing mental health in chronic care in general practice: a feasibility study of the Healthy Mind intervention.Scandinavian journal of primary health care · 2024Article
- Ethnographic research as an evolving method for supporting healthcare improvement skills: a scoping review.BMC medical research methodology · 2021Article
- Barriers to integrating routine depression screening into community low vision rehabilitation services: a mixed methods study.BMC psychiatry · 2020Article
- A pay for performance scheme in primary care: Meta-synthesis of qualitative studies on the provider experiences of the quality and outcomes framework in the UK.BMC family practice · 2020Article
- How do community-based eye care practitioners approach depression in patients with low vision? A mixed methods study.BMC psychiatry · 2019Article
- Barriers and enablers to screening and diagnosing depression and diabetes distress in people with type 2 diabetes mellitus; protocol of a qualitative evidence synthesis.HRB open research · 2019Article
- How older adults self-manage distress - does the internet have a role? A qualitative study.BMC family practice · 2018Article
- What does it take to set goals for self-management in primary care? A qualitative study.Family practice · 2016Article
- The Fracture of Relational Space in Depression: Predicaments in Primary Care Help Seeking.Current anthropology · 2016Article
- Base Rates of Depressive Symptoms in Patients with Coronary Heart Disease: An Individual Symptom Analysis.PloS one · 2016Article
- The triple whammy anxiety depression and osteoarthritis in long-term conditions.BMC family practice · 2015Article
- Depression Awareness and Self-Management Through the Internet: Protocol for an Internationally Standardized Approach.JMIR research protocols · 2015Article
- Understanding depression associated with chronic physical illness: a Q-methodology study in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2015Article
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6 authors.
Funding
Abstract
objectiveTo examine the process of case finding for depression in people with diabetes and coronary heart disease within the context of a pay-for-performance scheme.
designEthnographic study drawing on observations of practice routines and consultations, debriefing interviews with staff and patients and review of patient records.
settingGeneral practices in Leeds, UK.
participants12 purposively sampled practices with a total of 119 staff; 63 consultation observations and 57 patient interviews.
main outcome measureAudio recorded consultations and interviews with patients and healthcare professionals along with observation field notes were thematically analysed. We assessed outcomes of case finding from patient records.
resultsCase finding exacerbated the discordance between patient and professional agendas, the latter already dominated by the tightly structured and time-limited nature of chronic illness reviews. Professional beliefs and abilities affected how case finding was undertaken; there was uncertainty about how to ask the questions, particularly among nursing staff. Professionals were often wary of opening an emotional 'can of worms'. Subsequently, patient responses potentially suggesting emotional problems could be prematurely shut down by professionals. Patients did not understand why they were asked questions about depression. This sometimes led to defensive or even defiant answers to case finding. Follow-up of patients highlighted inconsistent systems and lines of communication for dealing with positive results on case finding.
conclusionsCase finding does not fit naturally within consultations; both professional and patient reactions somewhat subverted the process recommended by national guidance. Quality improvement strategies will need to take account of our results in two ways. First, despite their apparent simplicity, the case finding questions are not consultation-friendly and acceptable alternative ways to raise the issue of depression need to be supported. Second, case finding needs to operate within structured pathways which can be accommodated within available systems and resources.
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